Neuropsychology of Cerebral Palsy:Adapted Cognitive Assessment Laboratory Studies

Seth Warschausky, Ph.D.

Department of Physical Medicine and Rehabilitation; University of Michigan

ACAL Research Team University of Michigan

Core Faculty

Jacqueline Kaufman, Ph.D.

Marie Van Tubbergen, Ph.D.

Seth Warschausky, Ph.D.

Collaborators

Rita Ayyangar, M.D., MPH

Lynn Driver, M.S.; SLP

Judith Greenbaum, Ph.D.; Consultant

Research Administration Office

Nicole Miller, B.A.; RA

Donna Omichinski, B.A.; Project Coordinator

Mary Free Bed Rehabilitation Hospital Collaborators

Jacobus Donders, Ph.D., ABPP; Co-I

Shana Asbell, Ph.D.; Post-doctoral Fellow

Neuropsychology of CPs

Limited study and understanding of neuropsychological risks associated with CP subtypes, and very few studies that focus on specific neuropsychological domains; i.e., attention, executive functions, memory, visuospatial functions

Larger focus on neuropsychological risks of populations with history of low and very low birth weight and PVL, but not necessarily CP

CP Subtypes & Neuropsychological Domains

Spastic diplegia

Visuoperceptual impairments associated with evidence of periventricular leukomalacia

Possible multifactorial etiology for visuoperceptual impairments including developmental effects of impaired vision, oculomotor and general motor impairments

Dyskinetic

Some evidence of lower risk for impairments in specific domains including visuospatial, memory and executive function

Hemiplegia

36% with Specific Learning Disability

Inhibitory control(Christ, White, Brunstrom,

Abrams, 2003)

“High functioning” children

with bilateral spastic CP

typically associated with

PVL

Non-significant associations

between IQ and inhibitory

control

Significant impairments in

inhibitory control and

processing speed

Reading Acquisition

Much research showing that anarthria or

severe dysarthria does not preclude

developing phonological processing skill

Sandberg & Hjelmquist (1997), using

nonstandardized tasks, showed that among

nonvocal children with CP, ages 8 - 19, those

who could read had higher phonological

processing scores than the nonreaders.

Among 5-13 year olds with cerebral palsy, 20% were either unable to speak or not comprehensible to an unfamiliar person

29% required help for most tasks and 16.2% required help with all tasks

(Study-2, N.L.T. NLTS2 data tables. 2003. Available from:

http:/www.NLTS2.org)

Recognition of the limitations of traditional neuropsychological

assessment instruments and models

Long-standing concern that traditional cognitive measures are not accessible to children with significant communicative and motoric impairments(Allen, 1958; Byrne, Dywan, Connolly, 1995; Sabbadini, Bonanni, Carolesimo & Caltagirone, 2001; Tracht, 1948)

Neuropsychological knowledge derived from the typically developing (TD) population does not always apply to children with CP. For example, in TD children, articulation rate is associated with memory span -doesn’t hold for children with CP.

(Hulme, Thomson, Muir, & Lawrence, 1984; White, Craft, Hale, Park, 1994)

Addressing limitations of traditional testing: Adaptations from other

laboratories

Event-related Potential (ERPs): Byrne et al. (1995) assessed single word receptive vocabulary using congruent and incongruent computerized picture-word pairs (PPVT). Higher N400 negativity to mismatched pairs.

Dichotomous Choice: Sabbadini et al. (2001) used dichotomous choice formats for neuropsychological evaluations that included measures of phonological processing, grammatical comprehension, memory and reasoning.

The ACSESS Project

University of Michigan

Western Michigan University

United Cerebral Palsy Association of Michigan

Washtenaw Intermediate School District

Sponsored by:

U.S Department of Education

Office of Special Education Programs

Objectives of the ACSESS Project

Meet national initiatives to find more effective ways

of assessing educational progress of children with

special needs;

Increase awareness of the limitations of traditional

assessment instruments in accurately assessing the

skills and abilities for children who have significant

motoric, sensory or communicative impairments;

Combine the developments of assistive technology,

rehabilitation engineering and computerized and

alternate assessment.

SkillDescription

Forced Choice Yes / No

Responsiveness Will notice and attend, at least briefly, to novel stimulus

Preference Will communicate a general, affective response regarding personal preference

“Which picture do you like best?”

“Do you like this dog?”

Preference-Advanced

Will communicate a specific response signal regarding personal preference

“Which picture do you like best?”

“Do you like this dog?”

Directed Will communicate a specific response signal to questions unrelated to personal desires

“Which one is a fish?”“Which one is a dog?”

“Does this dog have a nose?”

“Is this dog black?”

Prediction Will communicate a specific response signal to questions requiring indirect application of knowledge

“Which one does not show an animal?”

“Which one barks?”

“Is this an animal?”“Can he fly?”

Van Tubbergen et al. (2008)

Modified Test Administration Using Assistive

Technology: Preliminary Psychometric Findings

Instruments and Procedures

•PPVT-III & Raven’s Coloured Progressive Matrices

tests provide estimations of overall intellectual ability.

•CTOPP Elision provides information on phonemic

awareness, an important predictor of reading

acquisition.

•PIAT-R/NU Reading Comprehension provides an

estimation of current reading ability.

•Standard and Adapted versions of each test were

administered in counterbalanced order.

•Children were randomly assigned to either a

HeadMouse® or pressure sensitive switch for AT

access in the modified versions of tests.

Standard and Modified Test Scores by Group

85

95

105

115

PPVT-III Raven's Elision PIAT_RC

Standard

Modified

*

85

95

105

115

PPVT-III Raven's Elision PIAT_RC

Standard

Modified

TD

CP*

*

Preliminary findings

Associations between Test Scores

Standard = Black

Modified = Red

PPVT-III

Raven’s

Elision

Reading

Comp

Typically Developing Cerebral Palsy

PPVT-III Elision

Raven’s Reading

Comp

Preliminary findings

Conclusions Preliminary evidence that modifying

neuropsychological tests to make them more accessible does not necessarily alter psychometrics

with notable exceptions, including test of phonological awareness and possibly types of IQ testing.

Poised for more comprehensive studies of

the neuropsychology of the CPs

phonological awareness and reading acquisition

medication effects

complex relations between cognitive capabilities and use of assistive technology.

The utility of findings for educational planning

The ACAL Project Website

For more information contact:

ANAC-Project@med.umich.edu

http://www.med.umich.edu/pmr/acal/index.htm